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SPATIAL DIFFUSION OF ZIKA FEVER EPIDEMICS IN THE MUNICIPALITY OF SALVADOR-BAHIA, BRAZIL, IN 2015-2016: DOES ZIKA FEVER HAVE THE SAME SPREAD PATTERN AS DENGUE AND CHIKUNGUNYA FEVER EPIDEMICS?
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Fundação Oswaldo Cruz. Escola Nacional de Saúde Pública Sergio Arouca. Programa de Pós-Graduação Stricto Sensu em Epidemiologia em Saúde Pública. Rio de Janeiro, RJ, Brasil.
Fundação Oswaldo Cruz. Escola Nacional de Saúde Pública Sergio Arouca. Departamento de Epidemiologia e Métodos Quantitativos. Rio de Janeiro, RJ, Brasil / Universidade do Estado do Rio de Janeiro. Instituto de Medicina Social. Rio de Janeiro, RJ, Brasil.
Fundação Oswaldo Cruz. Escola Nacional de Saúde Pública Sergio Arouca. Departamento de Epidemiologia e Métodos Quantitativos. Rio de Janeiro, RJ, Brasil / Universidade do Estado do Rio de Janeiro. Instituto de Medicina Social. Rio de Janeiro, RJ, Brasil.
Abstract
INTRODUCTION: The recent emergence and rapid spread of Zika and Chikungunya fevers in Brazil, occurring simultaneously to a Dengue fever epidemic, together represent major challenges to public health authorities. This study aimed to identify and compare the 2015-2016 spatial diffusion pattern of Zika, Chikungunya, and Dengue epidemics in Salvador-Bahia. METHODS: We used two study designs comprising a cross-sectional-to-point pattern and an ecological analysis of lattice data. Residential addresses involving notified cases were geocoded. We used four spatial diffusion analysis techniques: (i) visual inspection of the sequential kernel and choropleth map, (ii) spatial correlogram analysis, (iii) spatial local autocorrelation (LISA) changes analysis and, (iv) nearest neighbor index (NNI) modeling. RESULTS: Kernel and choropleth maps indicated that arboviruses spread to neighboring areas near the first reported cases and occupied these new areas, suggesting a diffusion expansion pattern. A greater case density occurred in central and western areas. In 2015 and 2016, the NNI best-fit model had an S-curve compatible with an expansion pattern for Zika (R2 = 0.94; 0.95), Chikungunya (R2 = 0.99; 0.98) and Dengue (R2 = 0.93; 0.99) epidemics, respectively. Spatial correlograms indicated a decline in spatial lag autocorrelations for the three diseases (expansion pattern). Significant LISA changes suggested different diffusion patterns, although a small number of changes were detected. CONCLUSIONS: These findings indicate diffusion expansion, a unique spatial diffusion pattern of Zika, Chikungunya, and Dengue epidemics in Salvador-Bahia, namely. Knowing how and where arboviruses spread in Salvador-Bahia can help improve subsequent specific epidemic control interventions.
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